Legionella community-acquired pneumonia (CAP) presenting with spontaneous bilateral pneumothoraces

Abstract

Legionnaires' disease is a common cause of non-zoonotic atypical community-acquired pneumonia (CAP). Legionnaires' disease has varied manifestations but may be diagnosed clinically on the basis of its characteristic pattern of extra-organ involvement. In a patient with non-zoonotic CAP, the clinical and laboratory features in a patient with CAP pointing to the diagnosis of Legionnaires' disease include relative bradycardia, mental confusion/ encephalopathy, loose stools/diarrhea, abdominal pain, mild/transient increases in serum transaminases, decreased serum phosphorous, a highly elevated C-reactive protein (CRP), elevated creatinine phosphokinase (CPK), highly elevated serum ferritin levels, or microscopic hematuria. The radiologic manifestations of Legionnaires' disease are varied and no radiographic appearance is pathopneumonic. Patchy infiltrates in Legionnaires' disease are symmetrical and rapidly progressive even on appropriate anti-Legionella antimicrobial therapy. Spontaneous unilateral pneumothorax is a rare radiographic manifestation of Legionnaires' disease. We present a case of a young male who is presenting clinical finding was that of spontaneous bilateral pneumothoraces due to Legionella CAP. We believe this is the first reported case of Legionnaires' disease presenting as spontaneous bilateral pneumothoraces. Clinicians should be aware of the protean radiological manifestations of Legionnaires' disease. In patients presenting with CAP and unilateral or bilateral spontaneous pneumothorax, clinicians should have Legionnaires' disease in the differential diagnosis.

Can we truly rely on the urinary antigen test for the diagnosis? Legionella case report

“…Hyponatremia occurs frequently in legionellosis 1, 6, 7, 8, 9, 10. Renal and hepatic dysfunction, elevated creatinine phosphokinase, thrombocytopenia, and leukocytosis are considered the common laboratory abnormalities.…”

“…Generally, in cases of LP, respiratory symptoms such as cough and sputum are not prominent at first. Hyponatremia occurs frequently in legionellosis . Renal and hepatic dysfunction, elevated creatinine phosphokinase, thrombocytopenia, and leukocytosis are considered the common laboratory abnormalities.…”

Clinical Features of COVID-19 and Differentiation from Other Causes of CAP

“…167 Pneumothorax is an unusual feature of other types of CAP. 168 Pneumothorax is associated with certain types of pneumonia such as Pneumocystis carinii pneumonia, 169 and other causes of ARDS, especially in those requiring mechanical ventilation. 170 Exact rates are difficult to compare across studies, but rates as high as 49% in the pre-lung protective ventilation era have been reported.…”

Case Discussion

“…Other clues not evident in this patient include hyponatremia (up to 50%), hypophosphatemia, increased CK, increased LDH, and relative bradycardia. [13][14][15][16][17] The rapidly progressive pneumonic consolidation in the patient was fairly typical, but nonspecific. Typical features include: focal infiltrates initially with contiguous spread to other lobes and bilaterally.…”